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Individual Risk Assessment
Dear Doctor,
Hope all is well. Here is my exposure:
I am a white, circumcised heterosexual male. One week ago I met a white woman of unknown status in a bar. She was around 25 years old. We had sex with a condom for one minute, at which point I couldn't feel anything so I (stupidly) took it off. We then had unprotected sex for three more minutes. As I still couldn't feel anything (I was very drunk), I stopped having sex with her. I did not ejaculate. I'm not even sure I felt enough for there to have been pre-cum. I asked her at the time whether she had STDs and she said no, but she also mentioned she had unprotected sex the prior evening with "some guy from Kentucky." Given this statement, and the fact that she was so sexually open with me (she positioned herself in doggy-style without my asking and had no issue with no condom), I'm assuming she's had a large number of partners. Also, she was obese, and I've read articles that obese women are more likely to have unprotected sex than non-obese women. Finally, I know from this forum that women of unknown status in bars are higher risk than sex workers even.
I tested negative for HIV just prior to this incident. Can you please assess my individual risk from this encounter (taking into consideration duration, no ejaculation, possibly no pre-cum, and the woman's promiscuity/randomness). I do not even have her phone number so I cannot ask her to get tested. Also, do you advise that I get tested for HIV/any other STDS? If so, how soon can I do this? Thanks so much for your guidance.
Hope all is well. Here is my exposure:
I am a white, circumcised heterosexual male. One week ago I met a white woman of unknown status in a bar. She was around 25 years old. We had sex with a condom for one minute, at which point I couldn't feel anything so I (stupidly) took it off. We then had unprotected sex for three more minutes. As I still couldn't feel anything (I was very drunk), I stopped having sex with her. I did not ejaculate. I'm not even sure I felt enough for there to have been pre-cum. I asked her at the time whether she had STDs and she said no, but she also mentioned she had unprotected sex the prior evening with "some guy from Kentucky." Given this statement, and the fact that she was so sexually open with me (she positioned herself in doggy-style without my asking and had no issue with no condom), I'm assuming she's had a large number of partners. Also, she was obese, and I've read articles that obese women are more likely to have unprotected sex than non-obese women. Finally, I know from this forum that women of unknown status in bars are higher risk than sex workers even.
I tested negative for HIV just prior to this incident. Can you please assess my individual risk from this encounter (taking into consideration duration, no ejaculation, possibly no pre-cum, and the woman's promiscuity/randomness). I do not even have her phone number so I cannot ask her to get tested. Also, do you advise that I get tested for HIV/any other STDS? If so, how soon can I do this? Thanks so much for your guidance.
MEDICAL PROFESSIONAL
Thanks for the link to the obesity information; I'll need to look up the survey data itself and study it. On reflection, the self-esteem business makes an association of obesity with poor sexual choices quite logical. However, please note that the news story points out that actual STD/HIV rates have not yet been analyzed with respect to body weight; and that the association with increased unsafe sex apparently applies only to overtly obese girls, apparently not those who are less overweight.
Urinalysis is not a substitute for actual gonorrhea/chlamydia testing. It often would be abnormal in someone with either infection, but not necessarily. That's soft reassurance at best and I'm glad to hear your doctor agreed to do the specific tests. You can expect negative results, but better safe than sorry. Even if positive, it will not have any significant effect on the risk of HIV.
Urinalysis is not a substitute for actual gonorrhea/chlamydia testing. It often would be abnormal in someone with either infection, but not necessarily. That's soft reassurance at best and I'm glad to hear your doctor agreed to do the specific tests. You can expect negative results, but better safe than sorry. Even if positive, it will not have any significant effect on the risk of HIV.
Hey doc, when you get a chance to answer my previous question can you also let me know whether a normal complete urinalysis is an indication that I don't have chlamydia and gonorrhea? I just had one done and the doctor said in all likelihood I don't have chlamydia or gonorrhea but he sent it out for the specific tests. Thanks!
Hey, Doc. Thanks for the prompt response. The thing about obese girls being more likely to have unprotected sex was from a recent Medical University of South Carolina study. Here is a link to a summary:
http://www.msnbc.msn.com/id/37344482/ns/health-kids_and_parenting/
Anyway, thanks again for your guidance. Your answer most definitely did help. All the best.
Oh one more thing actually: I will get a urine test for chlamydia and gonorrhea ASAP, as you have advised. If this test comes back positive for either/both, would that increase the chances I got HIV from this encounter or no? No more follow-ups, thanks in advance.
http://www.msnbc.msn.com/id/37344482/ns/health-kids_and_parenting/
Anyway, thanks again for your guidance. Your answer most definitely did help. All the best.
Oh one more thing actually: I will get a urine test for chlamydia and gonorrhea ASAP, as you have advised. If this test comes back positive for either/both, would that increase the chances I got HIV from this encounter or no? No more follow-ups, thanks in advance.
MEDICAL PROFESSIONAL
Welcome to the forum. Bottom line: No worries: there is no significant chance you caught HIV during this exposure. The risk probably is higher for other STDs.
In the US and other industrialized countries, no more than 1 in 1,000 sexually active women have HIV, even if they are habitually unsafe, as your partner apparently is. The maximum chance she had HIV, given the bar pick-up and willingness to skip the condom, probably is 1% (1 in 100). And even if she had HIV, with no condom the transmission risk would have been around 1 in 2,000. Combining those two odds, the chance you caught HIV probably is under 1 in 200,000.
You mention several factors that make no difference one way or the other: your partner's obesity (where did you get the notion that such persons are more likely to have unsafe sex???); sexual position; whether or not you had pre-ejaculate fluid; and whether or not you ejaculated. Ejaculation may increase HIV risk for the receptive partner in vaginal or anal sex, but makes no difference for the insertive partner.
So there's really no significant HIV risk. However, STDs are another matter, and it would make sense for you to visit your local STD clinic for evaluation. Normally that would include a urine test for chlamydia and gonorrhea (which can be done any time more than 2-3 days after exposure); and blood tests for syphilis and HIV, probably at around 6 weeks. However, in the meantime I really wouldn't be worried. For sure your HIV test result will be negative, and probably also your STD tests.
I hope this helps. Best wishes-- HHH, MD
In the US and other industrialized countries, no more than 1 in 1,000 sexually active women have HIV, even if they are habitually unsafe, as your partner apparently is. The maximum chance she had HIV, given the bar pick-up and willingness to skip the condom, probably is 1% (1 in 100). And even if she had HIV, with no condom the transmission risk would have been around 1 in 2,000. Combining those two odds, the chance you caught HIV probably is under 1 in 200,000.
You mention several factors that make no difference one way or the other: your partner's obesity (where did you get the notion that such persons are more likely to have unsafe sex???); sexual position; whether or not you had pre-ejaculate fluid; and whether or not you ejaculated. Ejaculation may increase HIV risk for the receptive partner in vaginal or anal sex, but makes no difference for the insertive partner.
So there's really no significant HIV risk. However, STDs are another matter, and it would make sense for you to visit your local STD clinic for evaluation. Normally that would include a urine test for chlamydia and gonorrhea (which can be done any time more than 2-3 days after exposure); and blood tests for syphilis and HIV, probably at around 6 weeks. However, in the meantime I really wouldn't be worried. For sure your HIV test result will be negative, and probably also your STD tests.
I hope this helps. Best wishes-- HHH, MD
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